Provider Demographics
NPI:1023186822
Name:MARUSCHAK, ROBERT MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:MARUSCHAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E MCKINLEY WAY
Mailing Address - Street 2:STE#2
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2071
Mailing Address - Country:US
Mailing Address - Phone:330-757-7713
Mailing Address - Fax:330-757-7715
Practice Address - Street 1:20 E MCKINLEY WAY
Practice Address - Street 2:STE#2
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2071
Practice Address - Country:US
Practice Address - Phone:330-757-7713
Practice Address - Fax:330-757-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-16441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH45985800Medicaid